What to Expect: IV Steroids (methylprednisolone)

You and your provider have decided that IV steroids are necessary for the exacerbation (also known as “relapses” and “attacks”) of your MS.
Steroid treatments for MS exacerbations are typically given intravenously (methylprednisolone) and typically on three consecutive days. This can be given in an outpatient setting or as a home infusion, as determined by your insurance coverage and your comfort level. In some cases, we may choose to repeat infusions or choose to treat with high dose pulse oral steroids instead.
Some of the short term side effects you may experience include*:

  • Metallic taste in mouth during and possibly after infusion
  • Stomach is upset, which in severe cases, can result in ulcers, bloody or black stools
  • Sleep disturbance (insomnia, sleepiness/fatigue)
  • Increased appetite
  • Water retention, swelling in hands, ankles, feet or rapid weight gain
  • Mood disturbance or unusual behavior
  • Muscle cramps, back pain
  • Headaches
  • Allergic reaction
  • Temporary frequent urination lasting one to two weeks after the infusion

* For a detailed list for long-term risks of IV steroids refer to Carenotes®

To minimize the most common the side effects, Virginia Mason’s MS specialists would make the following recommendations and offer you the following prescriptions:

  • Bring a few hard candies or mints with you to your infusion appointment
  • Avoid excessive salt intake
  • Watch what you eat, many patients experience weight gain with increased appetite
  • Ranitidine, available over the counter, to protect your stomach, and offer relief
  • Ambien®, available by prescription for sleep aid
  • Optional prescription for oral prednisone taper
    • The prednisone taper: This is a 14-day course of oral steroids (prednisone). The prednisone taper is recommended to be used under the following circumstances: you tolerated IV steroids well, but after stopping them you feel unwell, achy (“crash”); you tolerated steroids well and your symptoms improved, but after stopping steroids some of your symptoms reoccurred

In either of those circumstances the 14-day oral taper may help to ease some symptoms, but it is not known if it will benefit you in the long run.

Important things to remember about an exacerbation:

  1. Not every exacerbation has to be treated
  2. We have plenty of time to intervene: 
          • The conventional treatment for a relapse is IV steroids (solumedrol);
          • Steroids are thought to be effective when given up to 14 days after symptoms have peaked (been at their worst)
                   — The efficacy of steroids is questionable if it has been more than 14 days from when your symptoms peaked.
  3. Steroids can shorten the duration of symptoms, but generally do not impact how much you recover to your previous baseline.
          • Six months after your exacerbation, your condition should be essentially the same with or without steroids.
  4. In a typical exacerbation, the majority of recovery will take place six weeks after your symptoms peak. This is with or without steroids.
          • Even after this time and for up to six months, you may still experience slow, continued improvement of symptoms
          • We generally reserve any concern for “lingering,” “residual” symptoms for at least six months after the peak.
          • If six months after an exacerbation you still have lingering symptoms, it is possible these symptoms may be persistent.

Download What to Expect: IV Steroids (PDF)